CLIENT CASES
Clues:
This client loves collecting small objects.
They frequently pick up items such as paper, leaves, erasers, and small toys.
They have difficulty transitioning away from collected items.
They benefit from visual supports and limited choices.
Question:
Who is this client? What skill are we targeting?
Who is RaLa?
Target: Tolerating transitions away from preferred items (relinquishing reinforcement)
A therapist writes in their session note:"The client was being manipulative."
Why is this poor documentation?
What is Subjective?
Documentation should describe observable behavior (e.g., "The client screamed for 2 minutes and dropped to the floor after the demand was presented.").
A parent asks:
"What should I do when he screams at home? Should I ignore him?"
Question:
What should the therapist say?
"I can share that with the BCBA so they can discuss recommendations with you."
Therapists should not provide independent clinical recommendations outside their role.
During a 10-minute group activity, a client repeatedly gets out of their chair for 2–3 seconds before returning without prompts. The behavior occurs over 20 times.
What is Frequency?
Each occurrence has a clear beginning and end, and it's practical to count each instance.
Name these things about this staff member:
HARLEY
Favorite restaurant
Favorite coffee shop
Biggest fear
What is
Golden Corral
Fort Smith Coffee Co
Flying things that have stingers
Clues:
This client frequently engages in vocal stereotypy.
The behavior occurs across multiple activities.
Staff should avoid reinforcing by engaging in vocalizations.
Question:
Who is this client? What intervention is used for this client?
Who is EdRo?
Intervention is RIRD = Response Interruption and Redirection
A client independently completes work for 10 minutes. The therapist says, "Great job! One more worksheet." The client immediately begins crying and throwing materials.
What is Escape?
A client earns their token and asks for their reinforcer. Before the therapist delivers it, the client engages in screaming.
Question:
What should the therapist do?
Follow the token board/reinforcement procedure.
Do not remove already-earned reinforcement unless the plan specifically states that.
Remain neutral during problem behavior.
Reinforce appropriate behavior when client has calmed down
A client engages in a tantrum that includes crying, dropping to the floor, and refusing to respond. The episode lasts 14 minutes.
What is Duration?
The concern is how long the episode lasts rather than how many individual behaviors occur.
Name these things about this staff member:
HANNAH
Favorite Fast Food
Favorite season
Favorite music artist
What is
Chick Fil A
Fall
Dolly Parton
Clues:
This client engages in screaming when access to preferred items is denied.
The behavior has increased recently.
Data suggests the behavior is most likely maintained by access to tangibles.
Staff should focus on functional communication instead of giving the item after screaming.
Question:
Who is this client? What is the likely function and what replacement behavior should be reinforced?
Who is LeMe?
Function: Access to tangibles
Replacement: Requesting item, waiting, accepting "not available," appropriate requesting
A client engages in aggression with Therapist A approximately 10 times per session but only 1–2 times with Therapist B. Both therapists follow the same behavior plan.
What is one possible reason for this difference that should be investigated?
Differences in treatment fidelity
Differences in prompting
Reinforcement delivered differently
Therapist A presents more demands
Therapist B unknowingly reinforces the behavior
More data should be collected before drawing conclusions
A therapist says:
"The behavior plan doesn't work because he still screams sometimes."
Question:
What is the next step?
Do not independently change procedures.
Review whether the plan is being implemented correctly.
Collect accurate data.
Bring concerns to the BCBA.
A client leaves their seat 18 times during circle time. However, each time lasts only 1–2 seconds.
What is frequency?
The issue is how often the behavior occurs, not how long each instance lasts.
Name three things about this staff member:
KP
Favorite Holiday
Favorite Tv show
Favorite Color
What is
Zade's Birthday
SLMW
Pink
Clues:
This client uses an AAC device.
They can independently communicate some wants/needs.
They sometimes engage in throwing items.
Staff should redirect toward appropriate replacement behavior.
Question:
Who is this client? What should the therapist do when client throws items?
Who is TiBr?
Intervention used is DRA = Differential Reinforcement of Alternative Behavior and FCT = Functional Communication Training
Putting items in all done bucket and saying all done instead of throwing.
The behavior plan states:
Reinforce requests for a break.
Continue demands after the break ends.
During session: The client screams.
The therapist immediately provides a 10-minute break without prompting communication.
Question:
What part of the behavior plan was not followed?
The therapist reinforced screaming instead of reinforcing the replacement behavior (appropriate break request), which is a treatment integrity issue.
You notice that a client’s behavior is increasing. You review your data and realize it happens mostly with you, but not other therapists.
Question:
What should you do next?
Do not assume you are the cause or that the client "doesn't like you."
Review your own treatment implementation.
Ask for feedback/supervision.
Report the pattern to the BCBA.
Continue collecting accurate data.
A BCBA wants to know whether aggression is more likely to occur during transitions, table work, or free play.
What is ABC data?
The goal is to identify patterns and possible antecedents, not just measure occurrence.
Name three things about this staff member:
SOSS
Favorite coffee order (Starbucks)
Favorite candy
Favorite movie
What is
Brown sugar shaken espresso with vanilla cold foam
Bubs sour candy
Ace Ventura
Bonus points (1point) When Nature Calls
Clues:
This client engages in multiple behaviors including crying, dropping to the floor, and yelling.
Staff sometimes describe the behavior as "tantruming."
The behavior occurs most often when access to preferred activities is unavailable.
The replacement behavior involves appropriate requesting and waiting.
Question:
Who is this client? Why is "tantrum" not enough information for documentation? What should staff focus on instead of the behavior label?
Who is CaHo?
A therapist says,
"He's screaming because he doesn't like math."
Question:
Why is that statement inappropriate?
It assumes motivation/function without sufficient evidence. Therapists should report objective observations rather than conclusions.
A client screams during transitions. The therapist does not give the client the preferred item, but spends several minutes explaining:
"You can't scream. You need to use your words. Screaming doesn't work."
The client continues screaming.
Question:
What should the therapist evaluate?
Whether attention is unintentionally reinforcing the behavior.
Whether their response matches the behavior plan.
Whether they should reduce attention during problem behavior.
A client attends therapy for 2 hours on Monday and 4 hours on Tuesday. They engaged in aggression 12 times on Monday and 18 times on Tuesday.
What is Rate?
Because the sessions are different lengths. Frequency alone makes Tuesday look worse, but when you calculate:
Monday: 6 instances/hour
Tuesday: 4.5 instances/hour
Monday actually had the higher rate of aggression.
Scenario:
A therapist reports:
"The client had a bad day and was aggressive."
Question:
List at least 8 pieces of information the BCBA would need before making any clinical decisions.
What happened before?
What exactly did aggression look like?
Frequency
What happened after?
Staff response
Replacement behaviors used
Reinforcement delivered
Any setting events
Duration
Intensity